Provider Demographics
NPI:1417656513
Name:SMITH, RENEAU M (BHT)
Entity type:Individual
Prefix:MRS
First Name:RENEAU
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:BHT
Other - Prefix:
Other - First Name:RENEAU
Other - Middle Name:M
Other - Last Name:LANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:553 W 9TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-4066
Mailing Address - Country:US
Mailing Address - Phone:480-735-9705
Mailing Address - Fax:
Practice Address - Street 1:553 W 9TH ST APT 2
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-4066
Practice Address - Country:US
Practice Address - Phone:480-735-9705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
AZ175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty